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    The Vulture and the Phoenix: Neurosurgeon, Garven Wilsonhulme, the final great fight
    The Vulture and the Phoenix: Neurosurgeon, Garven Wilsonhulme, the final great fight
    The Vulture and the Phoenix: Neurosurgeon, Garven Wilsonhulme, the final great fight
    Ebook424 pages6 hours

    The Vulture and the Phoenix: Neurosurgeon, Garven Wilsonhulme, the final great fight

    By Carl Douglass

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    About this ebook

    Arthur Koestler, the notable twentieth century playwright said, Nothing is more sad than the death of an illusion." Carl Douglass, neurosurgeon turned author, writes with gripping realism about the point in Garven Wilsonhulme, M.D., F.A.C.S's life when he turns the hopes and aspirations of his family, friends, colleagues, and opponents into illusions. In so doing, he realizes that he has become both The Vulture and The Phoenix in his own life. He scrambles to the heights of fame, prestige, riches, and cruelty. There, he meets a wall of opposition and begins the final great fight of his complicated life and career. What he does will surprise and amaze you. This is the finale of the successful Saga of a Neurosurgeon series."
    LanguageEnglish
    PublisherPublication Consultants
    Release dateSep 30, 2015
    ISBN9781594333620
    The Vulture and the Phoenix: Neurosurgeon, Garven Wilsonhulme, the final great fight
    Author

    Carl Douglass

    Author Carl Douglass desires to live to the century mark and to be still writing; his wife not so much. No matter whose desire wins out, they plan an entire life together and not go quietly into the night. Other than writing, their careers are in the past. Their lives focus on their children, grandchildren, and great-grandchildren.

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      The Vulture and the Phoenix - Carl Douglass

      Phoenix

      CHAPTER

      One

      Medical students, interns, residents, and nurses referred to the medical school scientific laboratories as the rat labs or the dog labs, and the work that went on there as rat or dog surgery, a derogation indicative of the disdain of the clinician for the academician. The members of the university’s medical faculty knew that it was their life’s blood. If they were able to get something into print, however innocuous or obscure, they could keep their jobs. If they were able to do credible work, to make a real contribution, they would likely advance up the academic scale. If they were able to publish an important discovery that became widely known, they could almost name their reward. On the other hand, the best physician, the most talented surgeon, the most successful clinician or teacher would not last two years if he or she failed to list several articles in print or in publication, i.e., to be printed.

      Garven had been harboring an idea for some time, ever since he had worked with Dr. Harralsen in Phoenix. He had kept absolutely silent about it. He knew that academicians were not above frank theft of an idea; it was all part of the publish or perish ethic. Only the strong survived, and Garven intended, not only to persist, but to prevail in academia. His idea was insightful and simple. Spinal cord injuries that caused complete disruption of the spinal cord resulted in permanent failure of neurological function below the point of injury—quadriplegia or paraplegia, depending on the level of cord injury. Nothing anyone had done thus far had made any difference towards improving clinical neurological function. He reasoned that it might be possible to divert neurological impulses coming down the intact cord above to the level of the cord below the injury by a new technique.

      Others had tried and failed by simply sewing the severed ends of the cord together, and still others had hooked up electrical connections to try and stimulate the two halves, again to no avail. Garven proposed to take the long spinal nerves coming from the cord at the chest level, cut them, and make a bridge around the injury to the cord by uniting a nerve above to the one below. He considered uniting several nerves for good measure, but that would have to be reserved for later. He only had time for anastomosing single nerves since his clinical schedule was so busy.

      Garven had set up a very efficient lab. He trained an assistant who could do the preliminary work, even down to exposing the cord. He selected goats as his experimental animal because they had large intercostal spinal nerves that were easy to work with, and goats were inexpensive. He ordered a hundred goats, fifty to have the anastomoses after an experimental transection of the thoracic spinal cord and fifty to serve as controls. The controls were to have the cord exposed and cut, but no anastomosis. Three afternoons a week, he and his assistant, who became very proficient, did four animals. The animal lab personnel then took care of the paraplegic goats. Garven had to be patient and to wait and see if there would be either microscopic or electrophysiological evidence of transmission of electrical impulses from above to below or, more dramatically, improvement in clinical function in the lower extremities. The process took four months.

      The lab work was routine and leisurely. Garven learned to relax, to drink coffee, and to read the paper and journal articles. He rapidly became a typical researcher. He improved his fund of general knowledge on current events, such as learning that the super liberal, John F. Kennedy, approved the largest budget in U.S. history, with a projected deficit of $11,900,000,000—an amount that Garven knew would lead to the bankruptcy of his country. If that was not enough to guarantee ruination, Congress began consideration of a medical-hospital insurance bill for the elderly, a gigantic federal giveaway called Medicare. Martial law was declared in Cambridge, Maryland, and National Guard troops were dispatched to that city to control race riots. That kind of problem was fomented by communist agitators, Garven decided—people like a Negro minister and self-proclaimed black leader named Martin Luther King. The Reverend King led a scary march of 200,000 people in Washington D.C. to protest conditions for minorities. He gave a stirring speech, something about I have a dream… Garven just about decided that the country would not hold together long enough to go bankrupt if agitators like the reverend were allowed to continue.

      Where was J. Edgar Hoover and the FBI while all of this was going on? Garven muttered to himself.

      He had time now to observe his competition in the neurosurgery service and to record their errors. Alfred Grossner, the neurosurgeon with the good brain and the poor set of hands, was the most vulnerable to exposure. Garven recorded a patient who had one of his major lumbar nerve roots severed in a lumbar laminotomy operation. Grossner perforated the aorta on another lumbar disc patient, and the patient bled to death in the PAR. Garven’s competitor had very strange ideas for research and attempted to pursue them in humans without real thought as to the consequences. Garven scored his first coup over Grossner in the dog-eat-dog struggle for academic power by seeing to it that two of his most ill-thought-out ideas were uncovered and the patients protected.

      Dr. Grossner had an interest in the serious problem of vasospasm in the cerebral blood vessels after aneurysm rupture and subarachnoid hemorrhage. The blood from the torn aneurysm spread over adjacent vessels and proved to be caustic in some way. The irritated vessel walls constricted, sometimes to the point of being mere threads so slender that they could no longer carry blood and caused the patient to have a stroke. The condition was fatal at times. No one had found an antidote. Dr. Grossner observed that bee and snake venom caused marked relaxation in the walls of the blood vessels of lower animals. He failed to take note that the venoms also caused deaths.

      Grossner procured snake venom from a company in Arkansas that collected the dangerous material from a born-again religious cult that used rattlers in their religious rituals. The cult members brought in needed money by selling the snakes’ venom to the drug company. He obtained bee venom from an obscure company in Vermont. When he had sufficient quantities of each, he arranged for two patients in the NICU with vasospasm after subarachnoid hemorrhages to receive the venoms by vein. Garven was informed of the plan by Pat MacNamara, who was aghast at the entire concept. Garven whispered in the ear of the head nurse on neurosurgery, and she reported the planned human experimentation to her supervisor. The supervisor and the hospital administrator, in company with Peter Lyons, head of the department of surgery, showed up in the NICU at almost the last minute before Grossner was to instill the poisons into the patients’ IVs.

      There was a heated argument about academic freedom and interference with another doctor’s patient that made Al Grossner look more like the mad scientist than the innovative clinical investigator. Finally, Lyons had to issue an executive order for Grossner to desist permanently from his venom treatment, and in the process, the associate professor of neurosurgery was widely discredited. When the story got out and was spread around the faculty, with a little help from Garven, Alfred Grossner was made out to be a laughingstock.

      Grossner had another innovative idea. Many of the neurosurgery trauma patients had multiple injuries and developed severe infections. They received large amounts of wide-spectrum antibiotics to prevent or to treat their infections. One complication of the antibiotic treatment was the destruction of the normal bacterial flora of the patients’ intestines. Many of them developed an overgrowth of yeasts in the bowel that degenerated into very difficult infections related to the new, opportunistic organisms. The drug of choice to combat the systemic fungal and yeast infections was an extremely toxic chemical named Amphotericin B, and more commonly known as Ampho-Terrible by the house staff. In order to prevent or to cure the yeast infections without resorting to the use of Ampho-Terrible, Al Grossner hit on a novel idea.

      He decided that the reintroduction of normal bowel bacteria would be the answer to the yeast infection problem. He ordered the nurses to emulsify the stool of all of the uninfected patients on the ward and to dilute it with sterile water, and, as a refinement, to add mint flavor. Every patient on the ward was then required to drink a pint of the mint-flavored diluted excreta in the morning before breakfast and another at bedtime. The nurses had to scrub with disinfectant soap and to wear gloves at all times while they handled Dr. Grossner’s special medicine to prevent contamination with pathogenic bacteria from their hands. The head nurse on the ward complained to Garven that it made more sense to wash their hands after handling the medicine than before—something like doing hemorrhoid surgery.

      The experiment was to be Grossner’s and the nurses’ little secret, but Garven knew it was too good a story not to let it get out. He put a bug in the ear of the resident covering the infectious disease service, who alerted the chairman of the department of medicine. An investigation revealed the truth of the allegations, and Grossner’s experiment was summarily canceled. The treatment protocol gained notoriety and was labeled forever with Grossner’s name and with a series of descriptors, the most benign of which was detestable. It was hard for an intern or a resident to see Dr. Grossner without chuckling about his secret minty medicine.

      In mid-May, Garven’s own lab experiment bore fruit. Thirty-eight of his experimental goats developed a small but dramatic return of neurological function. They were able to control their bladders. Only one of the control group regained even the slightest bladder function. None of the goats demonstrated any return in motor function of their legs, but fifteen of the anastomosed goats appeared to have some return of sensation. That finding was questionable. Garven quietly informed the neurosurgery faculty of his findings in the first faculty meeting of June. Garven’s star was in an arc of ascendancy, about comparable to the arc of descendancy of Al Grossner’s aspirations.

      On his own, Dr. Grossner secured a position at the University of Pittsburgh, where there was a very forward-looking research professor of experimental neurosurgery. Al’s genius was recognized, and he was relieved of the burden of having to perform surgery on humans. In part, that opportunity was occasioned by Garven’s timely behind-the-scenes communication of his findings on Dr. Grossner’s operative complications. Garven’s hand in that matter went unheralded.

      Garven was offered the rank of assistant professor if he would agree to continue his work at UCOMH instead of considering the three offers he received from other universities. The information about those three offers was dropped very casually and modestly in passing by Garven to Dr. Chou’s secretary. No one asked for any verification of the offers; that would have been ungentlemanly. Garven had counted on that code of conduct by his superiors when he had the conversation with the secretary. He had learned a great deal about how the academic progression game was played, including the art of bluffing—perception was as important as reality—and it did not hurt to have had a couple of decades of practice playing poker with Apaches.

      CHAPTER

      Two

      Elizabeth went into labor on June 12. Garven felt more secure about this delivery than he had for Peter Arthur’s because he now had the prestige and inside track that his faculty membership afforded him. Against the advice of several of the younger obstetricians, both on the faculty and in the city, Garven had had Elizabeth see Dr. Horst Caesar, the head of the obstetrics department. His detractors accused Dr. Caesar of being both uncaring for his patients and of having only research interests. He would not give other physicians professional courtesy for their bills, Garven was told. Nonetheless, Garven went ahead and asked the professor to be his wife’s obstetrician. She had not entered into the discussion, confident that he knew best. Her parents were impressed with Dr. Caesar’s national reputation, and Garven’s ability to secure the man to be their daughter’s doctor lifted Garven a notch or two on their rating scale. Garven had been climbing that scale fairly steadily as his academic career status improved.

      It was a long, hard, and fitful labor. Elizabeth had pains steadily for hours, then she quit. Finally, at nine o’clock in the evening, she was certain that this was the real thing and had Garven take her to the hospital. She was admitted to the private wing. The doctor was not in and would not be until she was approaching time for delivery, the OB nurse informed them. Her examination revealed Elizabeth’s cervix to be about fifty percent effaced and three centimeters dilated at the time of admission. There was nothing to do but to wait.

      The pains were moderate in intensity and came six minutes apart for the next three hours. The nurse’s exam revealed eighty percent effacement and four centimeters of dilation, not a very impressive progress for all of that work. Garven asked the nurse to give his wife some morphine. The nurse was reluctant, but allowed herself to be persuaded to call Dr. Caesar. He ordered a small dose, two milligrams, and the nurse injected Elizabeth. The pain eased dramatically; unfortunately, by two o’clock, so did the contractions. The activity of Elizabeth’s labor fell to near nil. Garven called the nurse.

      This girl needs some Pitocin, he said. She’ll be here forever if you don’t.

      I’ll ask the doctor, but he won’t give her any. It’s three o’clock in the morning. Do you realize who you’re asking to come in here at that time? Because if she gets Pitocin, she’ll go into active labor, and he’ll have to come in. It’s more than my job’s worth to drag him out at night, if you want to know the truth.

      She left for the phone only when Garven insisted.

      He followed her to the nurses’ station. She did not see him as he listened to her end of the conversation with the famous obstetrician.

      Hello, Dr. Caesar, this is Millicent in OB… Yes, I know what time it is. I’m sorry, but Mrs. Wilsonhulme’s labor has just stopped, and her husband is insisting on her getting some Pit… I told him you wouldn’t, but he was really quite pushy about it. I must say, Doctor, that it doesn’t seem like such a bad idea… Yes, Sir, I know that it was his idea to give the morphine, and I do see where that got us… No, I guess that wasn’t the right decision… Yes, Sir, I know who the lady’s doctor is. I’ll tell them. Thank you, and good-bye. She turned around and saw Garven facing her. I guess you got the general idea of that conversation. The doctor said that he will be in to see your wife at eight o’clock. He said for you not to be a nervous husband.

      I am not a nervous husband. I am a doctor, and I know that my wife needs more care than she’s getting. She is becoming exhausted with unproductive labor. Call him back. I’ll talk to him.

      I can’t do that, Sir. We are absolutely forbidden to let the fathers talk to the OB. Please, I don’t want to get into trouble.

      I’ll tell you what, Garven said, controlling his anger, I will hold off if Elizabeth is making any progress at all. Let’s go back and check her.

      They did, and Elizabeth’s uterus was unchanged from the last examination. Garven walked purposefully out to the nurses desk and thumbed through the Rollidex of doctors’ numbers.

      You can’t do that, Sir. No fathers are allowed back here. Those are private numbers. I’m afraid that you’ll have to leave, whined Millicent.

      Garven memorized Dr. Caesar’s home number and put up his hands in surrender.

      Sure, I’ll go back to my wife, he said. Instead of returning to her labor room, he went on down the hall to the pay phone. He dialed Dr. Caesar’s number.

      The telephone rang four times. Dr. Caesar’s drowsy and irritable voice came on. It’s three forty-five in the morning, what do you want?

      And hello to you, Sir, Garven said, scarcely masking his sarcasm. This is Garven Wilsonhulme. My wife is Elizabeth, your patient in labor who has not seen her doctor yet.

      Do you know to whom you are speaking, Dr. Wilsonhulme? I don’t care for your tone.

      Yes, Sir, I know. You are Horst Caesar, my wife’s obstetrician. Now let’s get down to business. I know, and you know, that Elizabeth needs Pitocin. It is past time for her labor to get under way.

      Are you an obstetrician? Dr. Caesar’s voice was acid with sarcasm.

      I am not. I am nothing but a neurosurgeon, but I know when a patient is being neglected. That is apparent. I want you either to order Pitocin or to come in and see her like you ought to. I will get my own medicine and do the job myself if you don’t.

      Garven’s voice was cool and icy. He fought the urge to swear and yell at the arrogant ivory tower obstetrician.

      Be careful, young man. I sit on the advancement committee of this university. You may regret your outburst if you continue. I will write it off to your excessive emotional involvement in your wife’s labor this time. Give me the nurse. In the future, you let me handle the obstetrics, and you go and crack people’s heads. I don’t think you are any judge of what your wife needs.

      Garven handed the phone to Millicent.

      The Pitocin was given at four o’clock on the dot. Contractions began in ten minutes and were strong and active in twenty. Millicent’s serial examinations revealed steady effacement and dilatation. By ten after six, Elizabeth was fully effaced and at eight centimeters of dilation. She was also in terrible pain. Her contractions were three minutes apart, and she was unable to get any relief between them. At six-twenty, Garven confronted Millicent again.

      How about a little compassion, Millicent? This girl needs a paracervical block or an epidural, or a spinal, or gas. Something.

      I can’t do that; only the doctors.

      I know that. You have to call Dr. Caesar. He needs to get in here, big professor or not. His patient needs him, Garven insisted.

      He was angry enough to cause Millicent to know better than to argue. She took a big breath and called Dr. Caesar.

      Garven could not hear the conversation. He did not need to. He saw Millicent’s head shaking back and forth, translating the negative responses she was receiving into motor gestures. During a pause, Garven walked swiftly to where Millicent was standing with her back to him and snatched the phone out of her hand.

      This is Garven Wilsonhulme, he said peremptorily. It’s time—past time—for you to come and see your patient. She’s going to deliver soon, and she needs some help. I expect to see you in no more than thirty minutes, or I will have the administrator get an obstetrician from town.

      He put down the receiver without waiting for the indignant reply.

      In twenty minutes, Dr. Caesar walked into Elizabeth’s labor room. He was fumingly angry. Garven stood up. The delivery nurse stood so stiffly that she could have been at attention on a parade ground.

      Dr. Caesar cast an abrupt and condescending look at Elizabeth and asked, his question directed to the nurse, Is this our little girl who can’t handle a little pain?

      Elizabeth was in the middle of a long, hard contraction and was crying out in severe pain and fear.

      Garven transformed into a jungle animal protecting his female. He walked straight to the chief of OB-Gyn and took hold of both of the taller man’s suit coat lapels. Garven propelled the astonished full professor backwards into the hallway then whipped him around so that he was flattened against the wall. There was a look of the most terrible violence in his eyes and on his face. For the first time in his memory, Horst Caesar was afraid of a man, and the fear reached into his core.

      Garven’s voice was barely a whisper.

      That is my wife. She is delivering a baby. She will be treated with respect and with common decency. Even a dog would be helped by a reasonable human being. Now, you will go in there, get her some pain relief, get her baby delivered; and you will treat her as if she were the queen of England. I am going to be on your heels until this is over. Two things are going to happen to you if you treat my wife with disrespect again. The first is that I am going to beat you to within an inch of your life. The second is that I am going to call for a disciplinary hearing by the state medical licensing bureau. He swept the pale obstetrician around and pointed him towards Elizabeth’s door. That way, he said with quiet malevolence.

      Dr. Caesar examined Elizabeth. He looked embarrassed now, as well as angry and fearful.

      Well, young lady, you’ve made more progress than I thought. You’re at station one. We’d better get you into the delivery room. To the delivery room nurse, he said, Millicent, wheel her down there now. I’ll change and meet you in a minute.

      Without being asked, Garven helped wheel Elizabeth down the hall.

      At the entrance to the delivery room, Millicent said, Okay, Dr. Wilsonhulme, this is as far as you go. Dr. Caesar will be out as soon as we have a baby and let you know.

      Garven kept pushing the gurney on into the room.

      Don’t get in my way, he said.

      I don’t know what Dr. Caesar will think, what he’ll say, Millicent protested.

      But Garven was helping to shift Elizabeth onto the delivery table.

      He turned to the delivery room nurse once Elizabeth was settled and said, You are looking at me as if I were someone who gives a damn what Dr. Caesar thinks. What Dr. Caesar thinks and says on the matter of my presence in the delivery room is irrelevant right now.

      He went out, scrubbed, and donned his mask, cap, gown, and gloves.

      The delivery was a fait accompli in fifteen minutes. Garven and Elizabeth were the parents of a seven-pound, four-ounce baby girl. Dr. Caesar sewed up the small midline episiotomy while Garven held Elizabeth’s hand. They had agreed on Susan as a name if the baby were a girl.

      Is Susan all right? asked Elizabeth.

      She appeared wan and weary.

      Perfect, Garven said.

      Garven, I appreciate what you did. I know you took a risk by protecting me. It meant a lot. I will never forget, Elizabeth said.

      She sank back on the sweaty sheets.

      Horst Caesar came up to Garven in the dressing room afterwards.

      Look, I’m sorry things were unpleasant tonight. I consider this nothing more than the great anxiety of delivery, and I have no intentions of pursuing the matter further. Would you shake on that?

      Garven shook his hand. He knew it was not in his best interests to do anything more, either. He could not help but think that he had made another powerful enemy, every bit as vengeful as Henry Kowalski at the VA. He wondered when the latent animosity engendered by this night would resurface. In anticipation of that possibility, Garven made a very detailed set of notes about the case and included the pertinent information about all of the nurses who had been witnesses.

      CHAPTER

      Three

      Of necessity, with both Al Grossner and Don White gone permanently and David Stark off politicking around the country, Garven and Steven Chou became, if not fast friends, then the best of working partners. Steven had not been able to entice anyone he was impressed with to come and join the UCOMH faculty; so, he and Garven temporarily carried the full load. The residents were busy, and the new chief resident, Pat MacNamara, was doing more big cases than he ever dreamed possible in a training program. Garven immersed himself in his work. One Monday he scheduled a PCA (Posterior communicating artery) aneurysm, a posterior fossa procedure to remove a huge acoustic neurinoma, and a large glioblastoma located dangerously close to the left hemisphere speech area.

      His anesthesiologist was new, a woman. Garven arranged to do the posterior fossa case first and set the old man up in the sitting position for the procedure. The incision and bone removal went off routinely. Garven opened the dura, taking care to keep out of the large dural venous sinuses. They were very difficult to deal with when nicked.

      As he was tacking the dural leaves back out of the way, the anesthesiologist said, Dr. Wilsonhulme, Mr. Adams’ BP is going down. I can’t get it back up.

      There was an edge of panic in her voice.

      Did you hear any air through the Doppler? he asked.

      He was worried about the passage of air from the open cranial veins passing back into the heart. The bubbles could clog the heart and the outflow vessels.

      I think I might have. The Doppler tip is right by the heart, great position. I’ve never done a sitting position case before, and I’m not sure what the noise is like, she said.

      She manipulated the Doppler tube in its place inside the esophagus one more time just to be sure.

      You can’t miss it. Sounds like a washing machine. You can’t mistake that sloshing sound, Garven said.

      He had already covered the open incision with a heavy gauze pad and was pouring sterile normal saline over it constantly to prevent any more air from getting into the veins.

      Uh, oh! the anesthesiologist exclaimed. BP is zero. Now, what do we do?

      She was frankly panicked.

      Draw off the air in the right atrium! Garven said instantly.

      The anesthesiologist began to suck frothy blood from the upper cardiac chamber. Garven cranked the bed out of its upright sitting position and undid the head clamp from the table attachment. He had the orderlies help, and together they turned the patient over on his abdomen.

      BP is back! exulted the anesthesiologist.

      Great! sighed Garven. How about the air?

      Blood is clear now, no more bubbles.

      I’ll close him up, Garven said. He had the nurse hand him large sutures and the team turned the patient a little onto his side to permit suturing. It was very awkward, but Garven was making progress.

      Oh, no! He’s arrested. Flat line! the anesthesiologist shouted.

      Garven stopped his sewing. The entire crew set about to do the CPR. The EKG came back; it showed a normal sinus rhythm; but there was clear evidence that the man had suffered a major heart attack.

      He’s had an MI! moaned the anesthesiologist. We’re going to lose him!

      A myocardial infarction, the classical heart attack, was terrible anytime, but in the OR with an open wound it seemed to be an entire echelon worse.

      No we’re not, Garven said calmly in reply to the anesthesiologist’s negative outburst. Keep working!

      They got him stabilized and into the coronary care unit. He appeared to be doing reasonably well. The anesthesiologist came to Garven crying.

      I’m so sorry, Dr. Wilsonhulme. It’s all my fault. I know it. I can’t tell you how sorry I am.

      Sorry isn’t worth much. Learn the lesson from this case and get on with your work. It comes with the territory, Garven said, blandly.

      What are we going to do? she asked.

      She knew that her inexperience had not only injured the patient but had also wrecked the neurosurgeon’s schedule. She was a basket case and could only imagine how the surgeon had to feel.

      Garven looked at her for a moment then said, Send for the next patient.

      Are you kidding? she asked. I don’t think I have the courage to put another patient to sleep today, maybe never.

      Garven said without resentment or accusation, If you can’t stand the heat, you’d better get out of the kitchen. Now, let’s get back to work, it’s therapeutic.

      Pat MacNamara was in the hospital day and night. One weekend all year, he asked Garven to cover for him because his sister was getting married. It occurred to Garven to tell Pat what he had been told when he wanted to attend his own wedding—‘that’s what back stairs and student nurses are for’—but he was too soft hearted, he guessed. He agreed to cover for Pat. The chief resident looked over-tired, and Garven was afraid he would get sick and then Garven, himself, would have to revert back to being the de facto chief resident. That was a fate worse than death; so, he thought of doing the favor as the lesser of evils, a bit of insurance for himself.

      The junior resident, Hartley Lithum, called Garven in to help with a GSW of the head.

      It’s two fifteen, Hartley. Hasn’t Pat got you doing all the head trauma at night? He’s got a thought disorder if he hasn’t, Garven mumbled.

      This is a big problem, Garven. The dude has a bullet lodged right in his superior sagittal sinus. It’s a two man job if you know what you’re doing. I never even saw one of these before, Hartley confessed.

      Garven had. They were touchy. The superior sagittal sinus was a very large and critical venous channel that ran along the middle and top of the covering of the brain from front to back. If the sinus were to be cut across, there would be fatal bleeding. If it were tied off in the posterior one third, the brain would not be able to drain its blood and there would be fatal brain swelling.

      Where’s the bullet, Hartley? asked Garven.

      Where would you think? Murphy’s law holds in gun shot wounds to the head just like it does in every other situation.

      Posterior third?

      Yep.

      I’ll be right in. Get the OR nurses to find a bile duct ‘T’ tube and some silastic hose and sterilize them. We’ll need them.

      Okay, chief, Hartley said.

      Garven was so often the one that the residents turned to for help and the one who taught them how to operate and to take care of patients that they were falling into the habit of referring to him as ‘chief’. It was likely to prove a little embarrassing if the real chief, Dr. Chou, heard them.

      Garven refused to do the operation. He made Hartley do it all, even though the resident had never even seen the procedure. Hartley did a very careful craniotomy removing the mid posterior one-third of the skull. The dural veins were plentiful there, hanging down onto the brain. It was crucial to electrocoagulate each of them and to avoid letting them start to bleed because they retracted into the brain, and it was difficult to find them and get them under control before the brain was damaged if they started to hemorrhage. Hartley did a good job.

      Okay, Garven said, Let’s cut off a piece of temporalis muscle in case everything blows up, and we have to sew in a plug just to get out of here.

      Garven had Hartley put a large purse string suture around the sinus in front of the missile entry site and one behind it. The suture was left loose for future use.

      Now, let’s put a big temporary aneurysm clip on both ends.

      Hartley complied. There was no blood coming from the bullet hole.

      Okay, suck it up, Hartley. Time to take out the foreign body, Garven said.

      The scrub nurse automatically brought up a stainless steel kidney basin to catch the bullet when Hartley performed the age-old ritual. He extracted several bone fragments, then several smaller lead fragments.

      When he pulled out the last big piece of bullet, there was an eruption of bleeding from both ends of the cut venous sinus. Hartley looked slightly panicked.

      "Pull the purse string

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